How to Treat Engorgement: the Hardest Few Days of Breastfeeding

You’ve just brought your new baby home, and everything is going well. Baby is latching on and drinking beautifully, no nipple pain, no problems. “Why does everyone say breastfeeding is so hard?” you wonder.

And then, within a day, disaster strikes: your breasts are the size and consistency of boulders, your milk seems to be stuck in there, your breasts are in agony, your nipples feel like they’re about to fall off and your baby is one unhappy chap. How could so much go so wrong so quickly?

Welcome to postpartum engorgement.

What is engorgement?

To put it in really simple terms, engorgement happens when your breasts start to develop swelling in the breast tissue because there is too much milk in the breast. So it’s not just a case of your breasts being full of milk; the fatty tissue that surrounds the milk ducts inside the breast is swollen.

How to know if you’re engorged or just full

If you’ve ever had engorgement, you’ll know it’s a very different thing to just having full breasts – and by different I mean worse. Here’s a handy guide to help you tell whether it’s engorgement or just fullness:

FULL BREAST	ENGORGED BREAST
The milk ducts are full of milk, so the breast feels lumpy	The breast tissue is swollen, so the breast feels hard all over
The skin is normal	The skin is stretched tight and may look shiny
The nipple keeps its normal shape – it sticks out	The nipple is often stretched flat, and very difficult for baby to latch on to
The milk flows out of the breast easily	The milk doesn’t flow easily, perhaps only coming out in drops
Uncomfortable	Painful

 

How engorgement happens

The most common time for engorgement is around 3-7 days after the birth of your baby, when your milk starts to increase. Because baby is still quite small, the milk increases rather faster than baby can drink it – so your breasts end up getting fuller and fuller. All this pressure building up in the breast can actually irritate the breast tissue, which causes swelling.

Forewarned is forearmed

As with most things in life, preventing the problem in the first place is the path of wisdom. If you are still pregnant, and you’re reading this, you’ve already won most of the battle: by being prepared for engorgement, you can often prevent it entirely.

Since engorgement is caused by milk building up in the breast, preventing it is really based on one simple thing: keep the milk moving. Whenever you feel your breasts becoming overfull, remove some milk. The easiest way is to let your baby breastfeed as much as possible. If baby doesn’t want to drink enough to keep you comfortable (a common problem, since baby’s tummy is still tiny), express some of the milk so that your breasts don’t get hard. You will need to keep this up for a few days until things start to normalize.

Treating engorgement

Unfortunately, most women never get taught how to manage their milk increasing, and a fair number of us will end up engorged. If you do end up with engorgement, I can confidently say – both from my own experience and from observing countless other women – that it is probably the hardest week of your whole breastfeeding journey. The problem is not just that it hurts, but that it happens when you and baby are still figuring things out. But do not fear, help is here. I’ll spend the rest of this post explaining how you can treat engorgement and get things back to normal.

1. Get the milk out

This is really the most important point. The engorgement was triggered by an excess of milk, so in order to treat it, you have to get rid of some of that excess milk. This means breastfeeding and/or expressing as much as you need to, to get your breasts comfortable.

This, however, is easier said than done: babies often find it very difficult to latch on to an engorged breast, which makes breastfeeding difficult. And expressing isn’t really any easier: because of the swelling, the milk ducts are “squeezed” shut, and the milk doesn’t flow easily. But here are a few tricks that may help to get the milk moving:

Soften the areola to help baby latch

The reason why baby is struggling to latch, is because the nipple is hard and rigid, and doesn’t move into the baby’s mouth easily. You can make it easier on baby by softening the areola so that he can latch on more easily.

The first method is simple hand expression (if you’re not sure how to hand express, check it out here). This will remove some of the milk from the areola area and make it softer and easier to latch onto. If the breast is very swollen, however, hand expression by itself may not be enough.

The second method is a technique called Reverse Pressure Softening (RPS). With RPS, you are basically “pushing” the extra fluid that’s causing the swelling away from the areola and to the back of the breast. You need to place your fingers on the areola around the nipple: you can put the tips of the fingers on the areola around the nipple, or you can use the length of the fingers with the first joint of the fingers opposite the nipple (see the pictures below). Press back toward your chest until you feel the swelling “moving away” and softening – it usually takes around 30-60 seconds. Reposition your fingers on the next swollen area and repeat until you have softened a large enough area that baby can latch on more easily. Do this whenever you want to breastfeed and baby is struggling to latch on.

Use warmth to help the milk flow

Whether you’re expressing or breastfeeding, using a warm compress on the breast can really help the milk to flow. A warm compress can be as simple as a facecloth that you wet with hot water, although I find a hot wet cloth becomes cold very quickly. I prefer to use a hot “beanbag” – you can buy them, but it works just as well to fill an old sock with rice (or barley, beans or lentils) and pop it in the microwave for a minute.

If you are hand expressing, I recommend getting the whole breast submerged in hot water: either get into a hot bath or shower, or fill a basin with hot water and let your breasts dangle in it while you express and massage your breast. This is really the least painful way to soften the breast.

Do NOT let the milk build up!

Somewhere along the line, you’re bound to hear the myth that you shouldn’t express milk when you’re engorged, because it will just increase the milk production even further and make the engorgement worse. This is based on a misunderstanding of how the breast works: in order to increase milk production, you have to empty the breast several times a day – something you’re unlikely to be doing if you’re engorged! In fact, there’s some research that shows that in cases of “stubborn” engorgement, pumping the breast completely dry is the only thing that helps. So don’t be scared to express. Expressing to a comfortable level will not do anything to your supply, but it will prevent you from getting mastitis.

Pump or hand express?

For engorgement, I prefer hand expressing for two reasons: firstly, the pump can “pull” the swelling to the front of the breast, worsening the swelling in the areola and making it even harder for baby to latch on. Secondly, if you hand express you can do it under hot water, which makes it a lot less painful and more effective.

If you do prefer to pump, use only a low suction setting and massage or compress your breast as you pump to help the milk flow.

2. Bring the swelling down

Cold compresses

As any physiotherapist will tell you, cold packs help to reduce swelling. You get very fancy gel cold-packs that are shaped to fit nicely in your bra, but in all honesty, a bag of ice cubes wrapped in a towel works just as well. A bag of frozen peas makes quite a nice ice pack, since it shapes around the breast well. You can also put some water in a Ziploc baggie, drape it over a soup bowl and put it in the freezer – then it freezes into a nice breast-shaped ice-pack!

Always remember to wrap your icepack in a towel; you don’t want to get frostbite on your skin. Apply the icepack in a cycle of 10 minutes on, 10 minutes off.

Massage

Gentle massage of the breast can help to drain some of the extra fluid from the breast and bring down the swelling. The key word is gentle – you don’t want to hurt the breast; that would make the swelling worse. Gently stroking and soft kneading movements are all you need. It helps to lubricate your hands with a bit of oil – I like to use extra virgin olive oil, because it has anti-inflammatory properties. Some milk may start flowing as you massage, so be sure to keep a towel handy.

Cabbage leaves

Cabbage leaves are an old folk remedy that turns out to have some merit to it: when a cold cabbage leaf is applied to the skin, it releases an anti-inflammatory compound that helps to reduce the swelling. It’s more effective when the cabbage leaf is cold, so put it in the fridge or even the freezer. IMPORTANT: only keep the cabbage leaves in place for an hour or so; keeping it there for too long can lead to a decrease in milk production.

(Note: if you’re allergic to sulphites, don’t use cabbage leaves! I’ve heard that towels soaked in castor oil also do the trick, but I’ve never tried it; if you have, please let me know whether it works.)

Physiotherapy

Physiotherapists offer ultrasound treatment and LED light therapy that can work wonders for reducing inflammation and swelling. If you are struggling to get engorgement to resolve, it is definitely worth looking into.

3. Stay comfortable

Since a lot of the problem of engorgement is caused by inflammation, anti-inflammatory medications can help a lot. Most of the pain medications prescribed after giving birth (e.g. paracetamol and ibuprofen) are also anti-inflammatory, so they will also help speed your recovery from engorgement.

Make sure that you have a well-fitting, supportive bra. If your breasts are dangling free, it will hurt every time you move. But beware not to use a bra that is too tight; it can make the problem worse and cause blocked ducts to boot! I prefer a sports-type bra that covers the whole breast and does not have any wires or tight elastics.

Using hot and cold compresses, as described above, can also bring a lot of relief from pain.

Hang in there!

As I said in the beginning of this post, engorgement is often the worst few days of your breastfeeding journey. The good news, though, is that it really is just a few days. In less than a week, things will be back to a reasonable level of comfort and you’ll start to feel like you’ve got a handle on this. And from there it only gets easier with every passing day. So hang in there – I promise you, if you can just make it through the next few days, there are great times ahead!